Ramblings

Malcolm Gladwell's latest piece focuses on the silent brain damage that many football players suffer from, and asks whether it's inherent in the sport or whether it can be prevented.

The stained tissue of Alzheimer's patients typically shows the two trademarks of the disease—distinctive patterns of the proteins beta-amyloid and tau. Beta-amyloid is thought to lay the groundwork for dementia. Tau marks the critical second stage of the disease: it's the protein that steadily builds up in brain cells, shutting them down and ultimately killing them. An immunostain of an Alzheimer's patient looks, under the microscope, as if the tissue had been hit with a shotgun blast: the red and brown marks, corresponding to amyloid and tau, dot the entire surface. But this patient's brain was different. There was damage only to specific surface regions of his brain, and the stains for amyloid came back negative. "This was all tau," Ann McKee, who runs the hospital's neuropathology laboratory, said. "There was not even a whiff of amyloid. And it was the most extraordinary damage. It was one of those cases that really took you aback." The patient may have been in an Alzheimer's facility, and may have looked and acted as if he had Alzheimer's. But McKee realized that he had a different condition, called chronic traumatic encephalopathy (C.T.E.), which is a progressive neurological disorder found in people who have suffered some kind of brain trauma. C.T.E. has many of the same manifestations as Alzheimer's: it begins with behavioral and personality changes, followed by disinhibition and irritability, before moving on to dementia. And C.T.E. appears later in life as well, because it takes a long time for the initial trauma to give rise to nerve-cell breakdown and death. But C.T.E. isn't the result of an endogenous disease. It's the result of injury. The patient, it turned out, had been a boxer in his youth. He had suffered from dementia for fifteen years because, decades earlier, he'd been hit too many times in the head.

McKee got up and walked across the corridor, back to her office. "There's one last thing," she said. She pulled out a large photographic blowup of a brain-tissue sample. "This is a kid. I'm not allowed to talk about how he died. He was a good student. This is his brain. He's eighteen years old. He played football. He'd been playing football for a couple of years." She pointed to a series of dark spots on the image, where the stain had marked the presence of something abnormal. "He's got all this tau. This is frontal and this is insular. Very close to insular. Those same vulnerable regions." This was a teen-ager, and already his brain showed the kind of decay that is usually associated with old age. "This is completely inappropriate," she said. "You don't see tau like this in an eighteen-year-old. You don't see tau like this in a fifty-year-old."

It's interesting, sure, but the whole time I was thinking about the Army's new focus on Traumatic Brain Injury (TBI) and its relationship with Post Traumatic Stress Disorder. I'm also wondering what the long-term effects of these wars will be. If it's possible for a man who boxes in his 20's later suffers from Alzheimer's-like symptoms in his 60's, the VA is going to need to fund and conduct more long-term research on the link between brain trauma and mental degeneration. Before veterans and their families start asking questions around 2050.